As consulting ethicist and chair of the Bacharach Institute Ethics Committee, Melanie Wilson Silver, Ph.D. provides Bacharach administration, staff, physicians, patients and families with education about to the day-to-day ethical issues they face. She also provides Bacharach with consultation for the accreditation process by The Joint Commission and The Commission on Accreditation of Rehabilitation Facilities (CARF), as well as the New Jersey State Rehabilitation and Long Term Care surveys. Regulatory agencies such as these require that every health care institution that receives accreditation has a forum for the resolution of ethical conflicts.

Dr. Silver holds a master’s degree in health care ethics and law and a Ph.D. in health care ethics. She is an adjunct professor at Philadelphia University, teaching an ethics and professionalism course, and has published numerous journal articles. Dr. Silver explained, “This field changes from day-to-day. It is critical that we educate the medical community, the hospital community and the wider community, including families and patients, about the issues surrounding medical ethics as they continue to evolve.”

It is important that health care institutions offer a mechanism for consultation and support when an ethical issue arises. Frequently, these issues are related to advance directives and

“no-code” orders. Dr. Silver said, “We always want to be sure that we are honoring the wishes of the patient. Sometimes there is disagreement among family members as to what their loved one wanted, and the ethics committee is called in for support and consultation. We are acutely aware of family dynamics and really want to hear what everyone has to say.”

At Bacharach, the ethics committee, which meets once each month, consists of Dr. Silver, medical representatives including doctors, nurses and therapists from a range of clinical disciplines administrative representatives and external community members.

According to Dr. Silver, “The ethics committee is more important now than ever as we care for a diverse population with different cultures and ethnic backgrounds. Our role is to support patients and their families so we can understand where they are coming from and provide them with the support they need.”

When the ethics committee is called in for a consultation, which is always confidential, the consultation team works as an integrated unit. Dr. Silver sits down with other members of the health care team, such as a doctor, nurse and/or therapist, the patient and family members to discuss the situation – the consultation team gains insight by listening to everyone’s perspective before making its recommendations.

For example, if a living will states there should be no use of a feeding tube, but the patient is having trouble swallowing and it is indicated medically, the ethics consultation process is designed to slow things down so everyone can consider each other’s perspective and the best decision can be reached. Dr. Silver explained, “We are just one small moment in the life of these families. We work to help them accept the situation they are facing as a result of their changed circumstances.”

An interesting, new and very different approach to documenting patients’ wishes about their health care is the Physician Orders for Life Sustaining Treatment (POLST), which focuses on advance care planning by patients and does not require the involvement of a lawyer. The patient’s decisions are made known upon completion of a POLST form that becomes a documented medical order actionable immediately. This ensures that the patient’s wishes are being met as the health care process evolves. What makes POLST unique is that it is portable throughout the health care continuum, and unlike an advance directive, the document can be changed as medical circumstances change, and a legal guardian or next of kin is able to make changes if he or she is appointed by the patient to speak on the patient’s behalf.

At Bacharach, our patients come first. We are committed advocates on their behalf as we work to help them restore their independence and well-being by offering quality care in a supportive environment.